Title: Impact of Patient Safety Initiatives on Nursing Workflow and Productivity Abstract Since 2000, the public's attention has been captured by the reports of poor quality, safety risks, and errors in health care. Healthcare organizations, led by the AHRQ, CMS, and voluntary organizations, have instituted wave after wave of system interventions to improve quality and protect patients from errors. The interventions are important to quality and safety but they do increase demands on nurses' time in ways that are not currently measured. An invitational conference will be planned for fall of 2008 to address the impact of the rapid expansion of safety and quality activities on the workload of Registered Nurses caring for hospitalized patients. The goal of the project is to set the stage for determining the impact of the multiple, concurrent, internally and externally driven safety initiatives on nursing workflow, work demands, and productivity and subsequently on the overall quality and safety of patient care. The specific aims of the conference include: (a) Refine a conceptual framework explicating all factors affecting nurses' workload in acute care settings; (b) Achieve consensus on a research agenda and suggested measures and methods to describe nursing productivity, workload, workflow, and cost in relation to practice changes to improve safety and quality of care; and identify specific points at which these safety interventions increase workload and alter productivity; and (c) Explore staffing model changes and methods of streamlining support structures to accommodate the activities involved in patient safety initiatives. Invitees will include (a) persons who are studying nurses' workload measurement, nursing productivity, and the impact of patient safety initiatives; (b) those that hold positions in hospital administration who are accountable for patient safety initiatives and managing the work of health care practitioners, and (c) experts in research designs and analysis techniques for studying system issues. We will contract with selected scholars to produce and present up-to- date reviews of research on measuring nursing workload, work demands, and productivity; patient need for nursing care (intensity/severity); relevant data currently available; and policy relevant measurement. Nursing administration leaders will be asked to describe from their perspective the impact on their nursing staff of system interventions to improve patient safety and other pertinent challenges. Experts in design, measurement, and analysis of data will provide critique and guidance as suggestions for the research agenda and methods emerge. The proceedings of the conference including the initial review papers and the results of the discussion among participants and with the methods consultants will be disseminated through electronic means, publications in peer-reviewed journals, and presentations to stakeholders. Key Personnel Mary A. Blegen Director Nancy Donaldson Co-Director Jean Ann Seago Co-Director Susan Shapiro Co-Director Project Narrative There has been a rapid expansion of the safety and quality activities expected of Registered Nurses caring for hospitalized patients. Protecting patients from errors and omissions in their care is a crucial element of the nurses' role; however, we do not know the impact of these new multiple, concurrent, internally and externally driven, safety initiatives on nursing workflow, work demands, and productivity and subsequently on the overall quality and safety of patient care. This conference will bring together experts on the work of nurses and on ways to measure that work in order to develop valid approaches to studying this increase in work demands. [unreadable] [unreadable] [unreadable]